Transcript Anal Sacculectomy

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In normal digestion, the anal sacs work to promote
digestive constriction and passing of feces through
the anus
Periodically, the anal sacs may become impacted
and require routine and regular anal sac emptying
by placing slight pressure on the sac, removing the
impaction and fluid.
In situations where anal sac glands are not
expressed, or remain impacted, the development of
an abscess may occur.
(Cadena, 2006.)
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Some dogs (especially small) may have
frequent problems with their anal glands
› Examples may be..
 Anal Sac Impaction
 Abscesses
 Neoplasia
 Infection – (foul smelling,
pasty discharge)
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Bleeding, swelling, or redness
› Could be sticky drainage on either side of the
anus
› When the sac or duct becomes obstructed the
skin above the sac breaks open
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“Scooting”
Biting at rear end
Chasing tail
Excessive licking (rear end)
Pain & Straining to defecate
Obese cats
 Small dogs
 Older female dogs
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If frequent problems occur it is best to
just remove the problem itself, dogs (or
cats) do not NEED their anal glands
› Infection/Abscess
Neoplasia of the glands
 Tumor of sac wall
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A right anal
sacculitis
in a 12-year-old
female bulldog.
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A right anal sac
carcinoma in an 8year-old male bassett
hound.
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Incontinence if anal sphincter is cut or
damaged (caudal rectal nerve
damage)
› Considered permanent after 3 or 4 months –
sometimes it can resolve
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Failure to remove entire sac
› Resulting in continued secretion, infection or
fistulation
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Hemorrhage
Post-surgical complications
 Most dogs do well after surgery despite,
being quite painful for them
 Fecal incontinence may result from the
surgery
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Must treat impaction or infection before
surgery
 Antibiotics are giving preoperatively
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› Considered a contaminated surgery
Manual emptying of feces may be
necessary
 Two options for surgery
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› Open
› Closed
 Done on ferrets and neoplastic sacs
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OPEN
› Patient placed in perineal position with rolled
towel under caudal abdomen
› One blade of a pair of scissors is placed through
the duct into the sac, and the scissors are closed,
incising through the skin, SQ, external anal
sphincter, duct, and anal sac.
› Grasp the edges of the anal sac (grey and shiny)
with several hemostats.
› Dissect the sac free from the sphincter muscle
fibers with scissors or a 15 blade.
› A finger can be inserted into the open sac and
the blade scraped across the outside of the sac to
break away fibers.
› The sac is removed and the SQ and skin are
closed, or left open to heal by 2nd intention.
(Tobias, 2005)
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CLOSED
› In dogs is usually facilitated by inserting something into
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the sac (a Foley catheter, umbilical tape, hemostat)
unless there is a tumor in the sac wall.
The animal is prepped and placed in a perineal
position.
In the dog, something is inserted into the sac to
facilitate locating the tissue.
An incision (curvillinear) is made parallel to the anus
over the sac.
The sac is identified, and fibers of the internal and
external anal sphincter muscles are dissected off the
sac, staying directly against the sac to avoid vessel
and nerve damage (especially medially).
Ligate the duct at the mucocutaneous junction.
After gland removal, inspect the area to make sure no
mucosa is left.
Flush the area if contamination has occurred. Appose
the SQ and skin.
(Tobias, 2005).
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SURGERY WHEN CANCER INVOLVED
› The patient is placed in the standard perineal
position. A rolled towel is placed under the caudal
abdomen, and the hind limbs are not tied tightly in
order to prevent lesions to the femoral nerves.
› A purse string is not desirable either because the
surgeon might need access to the anal sac duct
opening. In some cases, parts of the rectal wall will
need to be sacrificed.
› Anal sac cancer can only be excised via the
closed technique, which provides a less
contaminated surgical site. Excision cannot be
reliably complete because sacrificing a large
portion of the anal sphincter will lead to fecal
incontinence.
A curvilinear skin incision is made at the 3 or
9 o’clock position. Via sharp and blunt
dissection, the mass is carefully excised.
 Hemostasis is performed with ligatures. The
duct, if still recognizable, can be ligated
with 3/0 or 4/0 absorbable, monofilament
suture material.
 After copious lavage, the remainder of the
external sphincter muscle is reapposed with
monofilament, synthetic, 3/0 suture
material.
 Subcutaneous and intradermal sutures are
placed. Skin sutures or staples are rarely
necessary. (Zeltzman, 2009).
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Cat/Small Medium
Large
Dog
Dog
Dogs
(20 lbs or (20-45 lbs (50 to 75
less)
or less)
lbs)
INTERNAL 4-0 or 3-0
Giant Dog
(75 lbs +)
3-0
3-0
3-0
SUBCUTAN
EOUS
4-0
4-0 or 3-0
3-0 or 2-0
2-0
SKIN
CLOSURE
4-0
4-0 or 3-0
or 2-0
3-0 or 2-0
2-0
Brand
Main
Choice
Also
Possible
Needle
Type
Needle Reference
Main
Choice
Also
Possible
INTERNA MONOCRY
L
L*
VICRYL*
PLUS
Taper Point RB-1, SH SH-1, CT-3
SUBCUTA MONOCRY
NEOUS
L*
VICRYL*
PLUS
PDS* II
VICRYL*
Taper Point RB-1, SH,
CT-2, CT-1
SKIN
ETHILON*
CLOSURE PROLENE*
Silk
Reverse
Cut
FS-2, FS- FSL, CP-2,
1, FS
CP-1, KS
Patient preperation
 Monitor Patient Vitals
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› TPR, Pulse Ox, Anesthetic Level, Etc
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Assist surgeon in cutting suture & handing
instruments
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Confinement (Restrict movement) and ECollar for 2 weeks
› Or until suture recheck/removal
Antibiotics
 NSAIDS & Opioids for at least 1 week
 A source of fiber (recommended to
prevent constipation)
 Pet may need help going to the
bathroom
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Getting pets anal glands checked &
expressed (if needed) regularly by a CVT
or DVM
› This can help prevent abscess and infection
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Anal gland must be expressed fully and
correctly to prevent infection!
Cadena, Christine (2006). Anal Sacculectomy; An overview of Anal Sac Glands and the Surgical Option. Yahoo Health and
Wellness. Retrieved 21 November 2010 from http://www.associatedcontent.
com/article/58209/anal_sacculectomy_an_overview_of_anal.html?cat=70
Novartis Animal Health . (2010). Anal Sacculectomy. Retrieved 21 November 2010 from http://www.ethicon.novartis.us/
surgeryOverview/anal/default.htm
Tobias, Karen. (2005). Abdominal and Gastrointestinal Surgery: Tips and Tricks. World Small Animal Veterinary Association.
Retrieved 21 November 2010 from http://www.vin.com/proceedings/Proceedings.plx?CID=
WSAVA2005&PID=10962&O=Generic
Zeltzman, Phil. (2009). Veterinary Practice News. Step by Step Surgery for Anal Gland Cancer. Retrieved 21 Novemeber 2010 from
http://www.veterinarypracticenews.com/vet-practice-news-columns/surgical-insights/step-by-step-surgery-for-anal-saccancer.aspx